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Kandala K, Archer HR, Moss KL, White B, Thomas BR, Wu D, Milner BE, Weintraub JA. Comparison of initial dental treatment decisions between in-person and asynchronous teledentistry examinations for people with special health care needs. J Am Dent Assoc 2024; 155:687-698.e2. [PMID: 38934969 DOI: 10.1016/j.adaj.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/19/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND People with special health care needs in long-term care settings have difficulty accessing a traditional dental office. The goal of the authors was to assess initial treatment decision concordance between dentists conducting traditional in-person examinations using mobile equipment and additional dentists conducting examinations using asynchronous teledentistry technology. METHODS Six dentists from Access Dental Care, a North Carolina mobile dentistry nonprofit, saw new patients on-site at 12 participating facilities or asynchronously off-site with electronic dental records, radiographs, and intraoral images, all captured by an on-site dental hygienist. Off-site dentists were masked to other dentists' treatment need decisions; 3 through 5 off-site examinations were conducted for each on-site examination. Demographic and binary treatment need category data were collected. For the 3 most prevalent treatment types needed (surgery, restorative, and new removable denture), the authors calculated the percentage agreement and κ statistics with bootstrapped CIs (1,000 replicates). RESULTS The 100 enrolled patients included 47 from nursing homes, 45 from Programs of All-Inclusive Care for the Elderly, and 8 from group homes for those with intellectual and developmental disabilities. Mean (SD) age was 73.9 (16.5) years. Among dentate participants, the percentage agreement and bootstrapped κ (95% CI) were 87% and 0.74 (0.70 to 0.78) for surgery and 78% and 0.54 (0.50 to 0.58) for restorative needs, respectively, and among dentate and edentulous participants, they were 94% and 0.78 (0.74 to 0.83), respectively, for new removable dentures. CONCLUSIONS The authors assessed the initial dental treatment decision concordance between on-site dentists conducting in-person examinations with a mobile oral health care delivery model and off-site dentists conducting examinations with asynchronous dentistry. Concordance was substantial for surgery and removable denture treatment decisions and moderate for restorative needs. Patient characteristics and facility type were not significant factors in the levels of examiner agreement. PRACTICAL IMPLICATIONS This evidence supports teledentistry use for patients with special health care needs and could help improve their access to oral health care.
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Alawadi A, AbdulAzees PA, Lin CY, Haney SJ, Hanlon JP, Angelara K, Taft RM, Amaechi BT. Application of organoselenium in inhibiting Candida albicans biofilm adhesion on 3D printed denture base material. J Prosthodont 2024; 33:460-466. [PMID: 37422719 DOI: 10.1111/jopr.13733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 07/06/2023] [Indexed: 07/10/2023] Open
Abstract
PURPOSE Denture Stomatitis, a chronic mucosal inflammation associated with Candida albicans, is common among denture wearers. Several health conditions have been linked to chronic Candida infections. The complex, multifactorial nature of denture stomatitis requires the continuous pursuit of effective long-term solutions. The present in vitro study investigated the effect of incorporating organoselenium into 3D-printed denture base resin on C. albicans adhesion and biofilm formation. MATERIALS AND METHODS Thirty disks were fabricated using 3D-printed denture base resin and assigned to three experimental groups (10/group): disks without organoselenium (control), disks with 0.5% organoselenium (0.5%SE), and disks with 1% organoselenium (1%SE). Each disk was incubated with approximately 1 × 106 cells/mL of C. albicans for 48 h. Microbial viability (CFU/mL) was quantified by the spread plate method, while Confocal laser scanning microscopy and scanning electron microscope were performed for quantifying the biofilm thickness and examining biofilm morphology, respectively. Data were analyzed using One-way ANOVA with Tukey's multiple comparisons test. RESULTS CFU/mL was significantly (p < 0.05) higher in Control when compared with 0.5%SE and 1%SE, but no significant difference between 0.5%SE and 1%SE. A similar trend was observed with biofilm thickness except that there was no significant difference between the Control and 0.5%SE. There was C. albicans biofilm adhesion on the Control disks, with yeast cells and hyphae formation, whereas on 0.5%SE and 1%SE, there was inhibition of yeast cells transition to hyphae formation. CONCLUSIONS Incorporation of organoselenium into 3D-printed denture base resin was effective in reducing C. albicans biofilm formation and growth on denture base material.
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Affiliation(s)
- Ahmad Alawadi
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - Parveez Ahmed AbdulAzees
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - Chun-Yen Lin
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
- Department of Family Dentistry and Oral Diagnosis, School of Dentistry, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Stephan J Haney
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - John P Hanlon
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - Konstantina Angelara
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - Robert M Taft
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
| | - Bennett T Amaechi
- Department of Comprehensive Dentistry, University of Texas Health Science Center at San Antonio, School of Dentistry, San Antonio, Texas, USA
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Go H, Jung HI, Ahn SV, Ahn J, Shin H, Amano A, Choi YH. Trend in the Incidence of Severe Partial Edentulism among Adults Using the Korean National Health Insurance Service Claim Data, 2014-2018. Yonsei Med J 2024; 65:234-240. [PMID: 38515361 PMCID: PMC10973558 DOI: 10.3349/ymj.2023.0380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Missing teeth is one of the most important indicators of oral health behavior and the result of dental caries, periodontal disease, and injuries. This study examined a trend in the incidence of severe partial edentulism (SPE) using the Korean National Health Insurance Service (KNHIS) data. MATERIALS AND METHODS Data of adults aged ≥20 years were obtained from the KNHIS for the 2014-2018 period. SPE was defined in dental information within a population with a treatment history of dental scaling as having 1 to 8 natural teeth. Crude incidence rates (CIRs) and age-standardized incidence rates (AIRs) with 95% confidence interval were calculated per 100000 persons. The Cochran Armitage trend (CAT) test and average annual percentage change were used to analyze SPE trends. RESULTS The CIRs among Korean adults were from 346.29 to 391.11 in 2014-2016 and from 391.11 to 354.09 in 2016-2018. The AIRs trend statistically increased by 4.31% from 346.29 to 376.80 and decreased by 4.72% from 376.80 to 342.10. The AIRs in men increased by 4.00% and decreased by 3.01%. The AIRs in women decreased by 2.18% and increased by 2.11% (CAT; p<0.01). The AIRs by region and income also showed trends of increase and decrease. CONCLUSION The study showed that the incidence trend of SPE increased and decreased from 2014 to 2018. This result would be able to aid in the planning of public oral health, and may also serve as fundamental data for verifying the impact of the public oral health policies implemented.
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Affiliation(s)
- Hyeonjeong Go
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Hoi-In Jung
- Department of Preventive Dentistry and Public Oral Health, College of Dentistry, Yonsei University, Seoul, Korea
| | - Song Vogue Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Jeonghoon Ahn
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Hosung Shin
- Department of Social and Humanity in Dentistry, Wonkwang University School of Dentistry, Iksan, Korea
| | - Atsuo Amano
- Department of Preventive Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Youn-Hee Choi
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
- Institute for Translational Research in Dentistry, Kyungpook National University, Daegu, Korea.
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Turton B, Alqunaybit G, Tembhe A, Qari A, Rawal K, Mandel E, Calabrese J, Henshaw M. Estimation of Oral Disease Burden among Older Adults in LTC: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:248. [PMID: 38541250 PMCID: PMC10970488 DOI: 10.3390/ijerph21030248] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/11/2024] [Accepted: 02/15/2024] [Indexed: 07/23/2024]
Abstract
Oral health is an essential part of healthy aging and very little data exists around the disease burden for older adults in a long-term care setting. The aim of this scoping review was to estimate the disease burden of dental caries, periodontal disease, and tooth loss among older adults in Long-Term Care (LTC). This scoping review was conducted in accordance with the Joanna Briggs Institute methodology. A detailed strategy was used to conduct a comprehensive search of electronic databases: PubMed, Embase, and Dentistry and Oral Sciences Source (DOSS). The Rayyan AI platform was used to screen abstracts for assessment by one of five co-investigators. Results indicate that only one in three might have a functional dentition upon entry into LTC, and among those who are dentate, most might expect to develop at least one new coronal and one new root caries lesion each year. There is a need to better document the disease experiences of this group to tailor approaches to care that might reduce the avoidable suffering as a result of dental caries and periodontal disease.
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Affiliation(s)
- Bathsheba Turton
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Gheed Alqunaybit
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Amrita Tembhe
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Alaa Qari
- Faculty of Dentistry, Umm Al-Qura University, Makkah 02131, Saudi Arabia;
| | - Kadambari Rawal
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Ernest Mandel
- Hebrew Seniorlife, Harvard Medical School, Boston, MA 02131, USA;
| | - Joseph Calabrese
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
| | - Michelle Henshaw
- Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA 02118, USA; (G.A.); (A.T.); (K.R.); (J.C.); (M.H.)
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Arany S, Eliav E, Medina-Walpole A, Caprio TV. Postgraduate dental resident education: A pilot in age-friendly "mentation" training. SPECIAL CARE IN DENTISTRY 2023; 43:765-771. [PMID: 37147183 DOI: 10.1111/scd.12871] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/12/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE Postdoctoral dental education in caring for older adults lacks didactic and clinical training in mentation topics, one of the core elements of the Age-Friendly Health Systems (AFHS) framework. Our primary goal was to launch a pilot project in clinical geriatrics focusing on older adults' mentation concerns, with a secondary goal to improve dental residents' confidence and competence in dental care and oral health. BACKGROUND Age-friendly care elements are not routinely incorporated into the dental education of residents caring for older adults with cognitive impairment or dementia. Therefore, we implemented a pilot educational project, providing the missing educational opportunity for residents in geriatric training covering cognitive impairment and focusing on Alzheimer's disease and related dementias. MATERIALS AND METHODS We designed educational sessions through a needs assessment, focus group discussions, and expert validation. We developed three e-Learning modules covering mentation concerns and dementia screening. We tested the modules in a pilot study of 15 dental postdoctoral residents as an essential part of their clinical practice. RESULTS The dementia dental learning module increased the residents' satisfaction with didactic preparedness (4.45 ± $ \pm \ $ 0.97) and knowledge acquisition (4.36 ± $ \pm \ $ 0.84). Residents strongly believed that learning about the AFHS-mentation topic would improve patient care. CONCLUSION Our pilot study is a pioneer project in support of a new AFHS-themed dental curriculum for clinical education. Further expansion of the age-friendly principles to include mobility, medications, and what matters to older adults will establish a model framework of redesigned geriatric dental education for academic centers.
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Affiliation(s)
- Szilvia Arany
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Eli Eliav
- Department of Dentistry, Eastman Institute of Oral Health, University of Rochester, Rochester, New York, USA
| | - Annette Medina-Walpole
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York, USA
| | - Thomas V Caprio
- Division of Geriatrics and Aging, Department of Medicine, University of Rochester, Rochester, New York, USA
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Jamieson L, Mejia G, Luzzi L, Ju X. Oral Health Inequities among CALD and Non-CALD Older Australians: A Decomposition Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6455. [PMID: 37568999 PMCID: PMC10418650 DOI: 10.3390/ijerph20156455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND Among Australia's older population, the burden of oral disease is disproportionality borne by culturally and linguistically diverse (CALD) communities. This study aims to examine changes in untreated decay surfaces (DS) between 2004-2006 and 2017-2018 among older CALD and non-CALD Australians. METHODS Data were sourced Australian national oral health surveys conducted in 2004-2006 and 2017-2018. An Oaxaca-Blinder decomposition analysis was used to assess the contribution of socio-demographics and dental behaviours. RESULTS A total of 246 CALD and 2853 non-CALD dentate participants aged 60+ years took part in 2004-2006, and 363 and 4278 in 2017-2018, respectively. There were increases in mean DS for both CALD (0.74 to 1.42) and non-CALD (0.72 to 1.50) groups between 2004-2006 and 2017-2018. The decomposition model showed that, for CALD participants in 2004-2006 with untreated DS, 40% of the contribution was from not having dental insurance; nearly three-quarters of the contribution was from last dental visit being over one year ago (72.9%) in 2017-2018. Among non-CALD participants in 2017-2018 with untreated DS, 42.5% of the contribution was from the last dental visit being over one year ago. CONCLUSIONS Our findings suggest that social determinants, including increased access to dental insurance, could mitigate the oral health inequities observed.
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Affiliation(s)
- Lisa Jamieson
- Australian Research Centre for Population Oral Health (ARCPOH), Adelaide Dental School, University of Adelaide, Adelaide, SA 5005, Australia; (G.M.); (L.L.); (X.J.)
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Thompson LA, Chen H. Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update. Clin Geriatr Med 2023; 39:225-234. [PMID: 37045530 DOI: 10.1016/j.cger.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.
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Affiliation(s)
- Lisa A Thompson
- Geriatric Dental Fellowship, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Helen Chen
- Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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Heaton B, Gondal N. Health-based homophily in public housing developments. BMC Public Health 2023; 23:238. [PMID: 36737700 PMCID: PMC9896682 DOI: 10.1186/s12889-023-15146-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023] Open
Abstract
Public housing residents in the United States face disproportionately high risks for disease, presenting an urgent need for interventions. Evidence suggests interventions leveraging social networks can be successful when relationships are homophilous, as this leads to pooling of risk behaviors among interconnected alters. Yet, we know little about networks of public housing residents. To assess the feasibility of network-based interventions, we investigate the incidence of health-based homophily in public housing developments in Boston, Massachusetts. Employing multilevel models (HLM), we find that respondents report their own health characteristics to be similar to their network partners on oral health, weight, and consumption of sugar-sweetened beverages and foods. We discuss the implications of our findings for health-based interventions in low-income communities.
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Affiliation(s)
- Brenda Heaton
- grid.189504.10000 0004 1936 7558Department of Health Policy & Health Services Research, Boston University Henry M Goldman School of Dental Medicine, Boston, USA ,grid.189504.10000 0004 1936 7558Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Neha Gondal
- grid.189504.10000 0004 1936 7558Department of Sociology and Faculty of Computing & Data Sciences, Boston University, Boston, USA
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Thompson LA, Kaplish S, Park SE, Chamut S. Is dental education meeting the oral health needs of older adults? J Dent Educ 2022; 86:1233-1241. [PMID: 36165248 DOI: 10.1002/jdd.13026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/10/2022] [Accepted: 06/11/2022] [Indexed: 11/07/2022]
Abstract
The aim of this article is to highlight the importance of promoting oral health for the geriatric population and implementing change to address their complex oral and systemic health needs. Oral healthcare providers are unequipped to meet the demanding oral health needs of the aging population, resulting in a geriatric oral health crisis that needs immediate attention and action. Despite the advancements in geriatric education over the last two decades, the geriatric curriculum in 2022 is still inadequate, and varies greatly among different US dental schools for both pre- and postdoctoral programs. Predoctoral students are graduating without being sufficiently trained to identify and treat the dental issues of older adults due to lack of a purposely planned curriculum with balanced didactic and clinical exposure. It is critical to have a trained and competent workforce that meets the oral health needs of current and future older adults. To change the present environment, there is a need for curriculum redesign, faculty development, and training. In addition, more research to evaluate pre- and postdoctoral geriatric dentistry curricula, their impact on increasing access to care, and the likelihood of graduating dentists competent to treat functionally dependent and frail older adults is needed. Furthermore, decision-makers in dental education, national dental organizations, and government institutions must support policies that integrate oral health into overall health through robust reimbursement mechanisms, including a dental benefit in Medicare, and recognition of geriatric dentistry as a specialty.
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Affiliation(s)
- Lisa A Thompson
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shivangi Kaplish
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Sang E Park
- Office of Dental Education, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Steffany Chamut
- Department of Oral Health Policy and Epidemiology and the Office of Global and Community Health, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,New York State Psychiatric Institute, Columbia University, New York City, New York, USA
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Critén S, Andersson P, Renvert S, Götrick B, Berglund JS, Bengtsson VW. Oral health status among 60-year-old individuals born in 1941-1943 and 1954-1955 and 81-year-old individuals born in 1922-1924 and 1933-1934, respectively: a cross-sectional study. Clin Oral Investig 2022; 26:6733-6742. [PMID: 35906339 DOI: 10.1007/s00784-022-04632-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941-1943 and 1954-1955 and 2 cohorts of 81-year-olds born in 1920-1922 and 1933-1934. MATERIAL AND METHODS The study was based on data from an ongoing longitudinal population project, The Swedish National Study on Aging and Care (SNAC). Oral health status was repeatedly examined clinically and radiographically in 2001-2003 and 2014-2015, including 60- and 81-year-olds, in total 412 individuals. Statistical analyses were performed using independent-samples t test and Pearson's χ2 test. RESULTS More individuals were dentate in 2014-2015 compared to 2001-2003 in the two age groups: 60 and 81 years (p < 0.001 for both). The mean number of teeth increased in the 60-year-olds from 24.2 to 27.0 and in the 81-year-olds from 14.3 to 20.2. The numbers of at least one intact tooth increased for both age groups (p < 0.001 and p < 0.004, respectively). In the age groups 81 years, there was an increase in having at least one PPD ≥ 6 mm (p < 0.016) and bone loss ≥ 5 mm (p < 0.029) between the two examinations. No such differences were found in the age groups of 60 years. CONCLUSION Over 13 years, oral health improved for both 60- and 81-year-old age groups. The most significant changes were in the 81-year-olds where oral health had improved except for periodontal status. CLINICAL RELEVANCE More natural teeth and impaired periodontal status potentially impact oral health and should increase focus on preventive and supportive dental care in older individuals.
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Affiliation(s)
- Sladjana Critén
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden.
| | - Pia Andersson
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden
| | - Stefan Renvert
- Faculty of Health Sciences, Kristianstad University, 291 88, Kristianstad, Sweden.,Department of Health, Blekinge Institute of Technology, 371 79, Karlskrona, Sweden
| | - Bengt Götrick
- Faculty of Odontology, Malmö University, 205 06, Malmö, Sweden
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Wei L, Griffin SO, Parker M, Thornton-Evans G. Dental health status, use, and insurance coverage among adults with chronic conditions: Implications for medical-dental integration in the United States. J Am Dent Assoc 2022; 153:563-571.e2. [PMID: 35287941 PMCID: PMC10026552 DOI: 10.1016/j.adaj.2021.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 12/02/2021] [Accepted: 12/29/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND The authors examined potential benefits and difficulties in integrating oral health care and medical care for adults with chronic conditions (CCs). METHODS The authors used National Health and Nutrition Examination Survey 2009-2016 data to estimate crude (age- and sex-standardized) and model-adjusted estimates to examine the association between dental disease (severe tooth loss, untreated caries) and chronic disease (≥ 3 CCs, fair or poor health) and Medical Expenditure Panel Survey 2014-2016 data to estimate crude estimates of past-year medical and dental use and financial access according to CC status. Reported differences are significant at P < .05. RESULTS National prevalences of reporting fair or poor health and 3 or more CCs were both approximately 15%. Standardized prevalence of dental disease was notably higher among adults reporting CCs than those not reporting. After controlling for covariates, the magnitude of the association was substantially lower, although the association remained significant. Adults with CCs were approximately 50% more likely to report having a past-year medical visit and no dental visit than those not reporting CCs. Among adults reporting CCs, prevalence of having no private dental insurance and low income was approximately 20% and 60% higher, respectively, than that among adults not reporting CCs. CONCLUSIONS Adults with CCs had higher prevalence of dental disease, past-year medical visit and no dental visit, and limited financial access. PRACTICAL IMPLICATIONS Medical visits may be the only opportunity to provide dental education and referrals to adults with CCs. Improved medical-dental integration could improve oral health care access and oral health among these adults who are at higher risk of dental disease.
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Gomez GGF, Cho SD, Varghese R, Rajendran D, Eckert GJ, Bhamidipalli SS, Gonzalez T, Khan BA, Thyvalikakath TP. Nutritional Assessment of Denture Wearers Using Matched Electronic Dental-Health Record Data. J Prosthodont 2022; 31:e53-e65. [PMID: 35322481 PMCID: PMC9545162 DOI: 10.1111/jopr.13505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 03/01/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose To assess the nutritional profile of denture wearers through a retrospective cohort study using nutritional biomarkers from matched electronic dental and health record (EDR‐EHR) data. Materials and methods The case group (denture wearers) included matched EDR‐EHR data of patients who received removable partial, complete, and implant‐supported prosthodontic treatments between January 1, 2010 and December 31, 2018, study time. The control (nondenture wearers) group did not have recorded denture treatments and included patient records within 1 year of the denture index date (first date of case patients’ receiving complete or partial denture) of the matching cases. The qualified patients’ EDR were matched with their EHR based on the availability of laboratory reports within 2 years of receiving the dentures (index date). Nutritional biomarkers were selected from laboratory reports for complete blood count, comprehensive and basic metabolic profile, lipid, and thyroid panels. Summary statistics were performed, and general linear mixed effect models were used to evaluate the rate of change over time (slope) of nutritional biomarkers before and after the index date. Likelihood ratio tests were performed to determine the differences between dentures and controls. Results The final cohort included 10,481 matched EDR‐EHR data with 3,519 denture wearers and 6,962 controls that contained laboratory results within the study time. The denture wearers’ mean age was 57 ±10 years and the control group was 56 ±10 years with 55% females in both groups. Pre‐post analysis among denture wearers revealed decreased serum albumin (p = 0.002), calcium (p = 0.039), creatinine (p < 0.001) during the post‐index time. Hemoglobin (Hb) was higher pre‐index, and was decreasing during the time period but did not change post‐index (p < 0.001). Among denture wearers, completely edentulous patients had a significant decrease in serum albumin, creatinine, blood urea nitrogen (BUN), but increased estimated glomerular filtration rate (eGFR). In partially edentulous patients, total cholesterol decreased (p = 0.018) and TSH (p = 0.004), BUN (p < 0.001) increased post‐index. Patients edentulous in either upper or lower arch had decreased BUN and eGFR during post‐index. Compared to controls, denture wearers showed decreased serum albumin and protein (p = 0.008), serum calcium (p = 0.001), and controls showed increased Hb (p = 0.035) during post‐index. Conclusions The study results indicate nutritional biomarker variations among denture wearers suggesting a risk for undernutrition and the potential of using selected nutritional biomarkers to monitor nutritional profile.
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Affiliation(s)
- Grace Gomez Felix Gomez
- Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
| | - Sopanis D Cho
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN
| | - Roshan Varghese
- GlaxoSmithKline consumer healthcare, Weybridge, United Kingdom
| | - Divya Rajendran
- Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN.,Innovation Associates, Inc., Indianapolis, IN
| | - George J Eckert
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Sruthi Surya Bhamidipalli
- Department of Biostatistics and Health Data Sciences, Indiana University School of Medicine, Indianapolis, IN
| | - Theresa Gonzalez
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN
| | - Babar Ali Khan
- Department of Pulmonary & Critical Care, Indiana University School of Medicine, Indianapolis, IN
| | - Thankam Paul Thyvalikakath
- Department of Cariology, Operative Dentistry & Dental Public Health, Indiana University School of Dentistry, Indianapolis, IN.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN
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13
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Jiang CM, Chu CH, Duangthip D, Ettinger RL, Hugo FN, Kettratad-Pruksapong M, Liu J, Marchini L, McKenna G, Ono T, Rong W, Schimmel M, Shah N, Slack-Smith L, Yang SX, Lo ECM. Global Perspectives of Oral Health Policies and Oral Healthcare Schemes for Older Adult Populations. FRONTIERS IN ORAL HEALTH 2022; 2:703526. [PMID: 35048040 PMCID: PMC8757822 DOI: 10.3389/froh.2021.703526] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to present a concise summary of the oral health policies and oral healthcare schemes for older adult populations in a number of selected countries around the world. In this paper, the current and planned national/regional oral health policies and oral healthcare schemes of nine countries (Australia, Brazil, China including Hong Kong, India, Japan, Switzerland, Thailand, the United Kingdom, and the United States) are reported. Barriers and challenges in oral health promotion in terms of devising oral health policies, implementing oral health schemes, and educating the future dental workforce are discussed. In response to the aging of population, individual countries have initiated or reformed their healthcare systems and developed innovative approaches to deliver oral health services for older adults. There is a global shortage of dentists trained in geriatric dentistry. In many countries, geriatric dentistry is not formally recognized as a specialty. Education and training in geriatric dentistry is needed to produce responsive and competent dental professionals to serve the increasing number of older adults. It is expected that oral health policies and oral healthcare services will be changing and reforming in the coming decades to tackle the enduring oral health challenges of aging societies worldwide.
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Affiliation(s)
- Chloe Meng Jiang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Chun Hung Chu
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | | | - Ronald L Ettinger
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, United States
| | - Fernando Neves Hugo
- Department of Preventive and Social Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Jian Liu
- Peking University School & Hospital of Stomatology, Beijing, China
| | - Leonardo Marchini
- The University of Iowa College of Dentistry and Dental Clinics, Iowa City, IA, United States
| | - Gerry McKenna
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Takahiro Ono
- Division of Comprehensive Prosthodontics, Niigata University Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Wensheng Rong
- Peking University School & Hospital of Stomatology, Beijing, China
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Naseem Shah
- Centre for Dental Education and Research, All India Institute of Medical Sciences, New Delhi, India
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Stella X Yang
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
| | - Edward C M Lo
- Faculty of Dentistry, The University of Hong Kong, Hong Kong, China
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14
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Systematic Review of the Literature on Dental Caries and Periodontal Disease in Socio-Economically Disadvantaged Individuals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312360. [PMID: 34886085 PMCID: PMC8656978 DOI: 10.3390/ijerph182312360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 12/23/2022]
Abstract
Dental caries and periodontal disease represent a health problem and a social cost for the entire population, and in particular for socio-economically disadvantaged individuals who are less resistant to disease. The aim of this review is to estimate the prevalence and severity of the two dental pathologies, caries and periodontal disease, in the different classes of socio-economically disadvantaged subjects and to understand which of them are most affected. A systematic search of the literature was performed in MEDLINE (via PubMed), EMBASE and Web of Science after establishing a suitable search strategy for each database, using keywords related to socio-economically vulnerable classes and health outcomes. Socio-economically disadvantaged individuals are more susceptible to tooth decay and periodontal disease (with relative tooth loss) than non-vulnerable people. Additionally, when multiple vulnerabilities are combined in the same subject, these oral diseases worsen. There is no type of vulnerability more affected by caries and periodontitis than others, since overall they all have severe disease indices. The data from this systematic literature review might be useful for health policy makers looking to allocate more resources and services to socially disadvantaged individuals, resulting in making them more resilient to oral disease due to their social marginalization.
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15
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Berg-Warman A, Schiffman IK, Zusman SP, Natapov L. Oral health of the 65+ age group in Israel-2020. Isr J Health Policy Res 2021; 10:58. [PMID: 34696813 PMCID: PMC8543889 DOI: 10.1186/s13584-021-00494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background In 2019, a reform of dental services for older adults was implemented in Israel to improve access and reduce barriers that stood in their way. The reform stipulated that preventive and restorative dentistry would be included in the basket of services of the National Health Insurance Law. The current study was conducted by the Myers-JDC-Brookdale Institute (MJB) and the Division of Dental Health of Israel’s Ministry of Health to examine the dental status and patterns of utilizations of dental services among the 65+ age group. This paper reports on the dental status of the 65+ age group in comparison with the same population two decades earlier. Goals To describe the dental status of Israel’s 65+ age group, and to identify the population at risk of dental morbidity. Methodology Telephone interviews were conducted with a representative sample of 512 older adults aged 65+, from February to April 2020. Main findings Some two-thirds of the 65+ age group assessed their oral health as good or very good. Twenty-four percent did not have natural teeth, while the rest had 19 teeth on average. Ten percent had not lost any teeth. In the 65–74 age group, 19% had no natural teeth and the rest had 20 teeth on average. In contrast, in the 85+ age group, 38% were edentulous and the rest had 13 teeth on average. Of the older adults who found it difficult to cover their monthly expenses, 39% were edentulous—twice the percentage of those who did manage to cover their monthly expenses (19%). Of the 65+ age group 44% had dentures—37% in the 65–74 age group, and 66% in the 85+ age group. Approximately 40% of the 65+ age group saw a dentist for preventive check-ups. The rest did not, mainly due to lack of awareness of the importance of doing so. Conclusions and recommendations The perceived status of oral health among the 65+ age group is currently better than it was 22 years ago. However, despite the improvement in oral health and health behavior, there are still barriers to the utilization of dental services. The main barriers are a lack of awareness of the importance of proper health behavior, and the cost of care for people with financial difficulty. This study provides decision-makers with data on the status of oral health, the utilization of dental services and the geographical disparities. The findings will help policy makers evaluate the effectiveness of the reform and fine tuning it in the future. Policies should be instated to increase awareness of constituencies and their access to the services, in addition to the entitlements the reform granted.
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Affiliation(s)
| | | | - Shlomo P Zusman
- Division of Dental Health, Ministry of Health, Jerusalem, Israel
| | - Lena Natapov
- Division of Dental Health, Ministry of Health, Jerusalem, Israel
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16
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Raju K, Taylor GW, Tahir P, Hyde S. Association of tooth loss with morbidity and mortality by diabetes status in older adults: a systematic review. BMC Endocr Disord 2021; 21:205. [PMID: 34663281 PMCID: PMC8524900 DOI: 10.1186/s12902-021-00830-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 07/27/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE This systematic review assesses the association of tooth loss (TL), as the exposure, with morbidity and mortality by diabetes mellitus (DM) status, as the outcome, in older adults. BACKGROUND Individuals with DM have higher prevalence of severe TL and increased risk of developing morbidities and mortality. No systematic review has evaluated the association between TL with morbidity and mortality by DM status. MATERIAL AND METHODS Comprehensive searches used multiple publication databases containing reports published between 01/01/2000 and 04/21/2021. Two authors independently evaluated included studies for quality and risk of bias using the Critical Appraisal Skills Programme (CASP) checklist for cohort and Center for Evidence-Based Medicine (CEBM) critical appraisal sheet for cross-sectional studies, while a third author arbitrated decisions to resolve disagreements. RESULTS Thirteen studies met the inclusion criteria: eight cross-sectional and five cohort. Qualitative review of the included studies indicated TL is associated with increased incidence and prevalence of DM. TL is also associated with DM-related morbidities including greater prevalence of heart disease, diabetic retinopathy, metabolic syndrome; poorer health-related quality of life; poorer survival of participants with chronic kidney disease; and increased medical expenditure. Overall, the quality of the evidence reviewed was medium, as per the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. CONCLUSIONS/PRACTICAL IMPLICATIONS This review found significant associations of TL with prevalence and incidence of DM and adverse DM-related outcomes. An interprofessional team-care approach that includes an oral health component could benefit the prevention and management of DM.
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Affiliation(s)
- Karen Raju
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California, 707 Parnassus Avenue, Box 0758, San Francisco, CA 94143-0758 USA
| | - George W. Taylor
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California, 707 Parnassus Avenue, Box 0758, San Francisco, CA 94143-0758 USA
| | - Peggy Tahir
- University of California, UCSF Library, 530 Parnassus Ave, San Francisco, CA 94143-0840 USA
| | - Susan Hyde
- Department of Preventive and Restorative Dental Sciences, Division of Oral Epidemiology and Dental Public Health, School of Dentistry, University of California, 707 Parnassus Avenue, Box 0758, San Francisco, CA 94143-0758 USA
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17
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Gaskin DJ, Zare H, McCleary R, Kanwar O, Davis AL. Predictors of Unmet Dental Health Needs in US Adults in 2018: A Cross-Sectional Analysis. JDR Clin Trans Res 2021; 7:398-406. [PMID: 34323109 DOI: 10.1177/23800844211035669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To identify predictors of unmet dental needs for adults 18 y of age or older in the United States. METHOD Using the Aday and Andersen framework and data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS), we ran logistic regression to estimate predictors for adults of not having a dental visit within 5 y and having lost any teeth using a national sample of 155,060 survey respondents. RESULTS Results showed that predisposing factors (age, race/ethnicity, gender, and educational attainment) and enabling factors (income and health insurance status) are important predictors for losing teeth due to decay or gum disease. Men, the elderly, and less educated and low-income residents were less likely to have seen a dentist within the past 5 y and more likely to have lost their permanent teeth. Compared to non-Hispanic White adults, Hispanics adults were more likely to have had a dental visit within the past 5 y. Unmet dental needs varied across states. People living in states with extensive Medicaid dental care benefit coverage were less likely to lose their teeth and more likely to have had a dental visit within the past 5 y. CONCLUSION Efforts to improve oral health should address unmet dental needs of men and adults with low socioeconomic status. Studying the variation between state oral health care programs could further our understanding of how public policy can improve population oral health. KNOWLEDGE TRANSFER STATEMENT Men, non-Hispanic Blacks, mixed and other race minorities, and low socioeconomic status adults are most at risk of unmet dental needs. States can address these needs by expanding Medicaid coverage for adults.
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Affiliation(s)
- D J Gaskin
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - H Zare
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Global Health Services and Administration, University of Maryland Global Campus (UMGC), Baltimore, MD, USA
| | - R McCleary
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - O Kanwar
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - A L Davis
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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18
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Oral hygiene and health-related quality of life in institutionalized older people. Eur Geriatr Med 2021; 13:213-220. [PMID: 34313976 PMCID: PMC8860786 DOI: 10.1007/s41999-021-00547-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/16/2021] [Indexed: 11/18/2022]
Abstract
Aim We evaluated oral hygiene level and its association with oral health and general health-related quality of life (HRQoL) among older residents in long-term care facilities. Findings Only one-fifth of residents had good oral hygiene. Poor oral hygiene was associated with poor oral health and diminished HRQoL. Message Oral hygiene, oral health, and HRQoL may be improved with oral care education of caregivers, professional cooperation, and regular oral healthcare of older residents in long-term care facilities. Purpose We evaluated the level of oral hygiene and its association with oral health status and need for oral treatment among older residents in long-term care facilities. In addition, the association between oral hygiene level and health-related quality of life (HRQoL) was explored. Methods This cross-sectional study assessed 231 dentate residents in long-term care facilities (71% female, mean age 81 years, 70% had dementia). Nurses assessed residents and completed questionnaires on participants’ background information, diagnoses, oral healthcare habits, and HRQoL with the 15D instrument. Two qualified dentists performed clinical oral examinations (number of teeth, plaque index, periodontal condition, open caries lesions, and dry mouth). We used a modified plaque index (PI) to measure the level of oral hygiene (good, moderate, and poor) and calculated the clinical Asymptotic Dental Score (ADS) to determine the oral inflammation burden. Results Of the residents, 21% had good, 35% moderate, and 44% poor oral hygiene according to PI. Poor oral hygiene was associated with poorer cognitive status (P = 0.010) and higher oral inflammation burden (P < 0.001). Moreover, poor oral hygiene was associated with poorer HRQoL in a correlation analysis adjusted for age and gender. Conclusions Oral hygiene of older individuals in long-term care is insufficient. Poor oral hygiene is a marker for poor HRQoL. Residents also have a high burden of oral inflammatory diseases and a need for dental care. Older residents’ oral hygiene and HRQoL may be improved with oral care education of caregivers and regular dental check-ups.
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19
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Singhal A, Alofi A, Garcia RI, Sabik LM. Medicaid adult dental benefits and oral health of low-income older adults. J Am Dent Assoc 2021; 152:551-559.e1. [PMID: 34176569 DOI: 10.1016/j.adaj.2021.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 02/13/2021] [Accepted: 03/07/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Older adults are keeping their natural teeth longer, spurring calls for dental coverage under Medicare. Although Medicare dental coverage would benefit all older adults, the poorest among them are already eligible for dental benefits through Medicaid. The authors examine the association between states' Medicaid adult dental benefits and dental care use and tooth loss among low-income older adults. METHODS Using the Behavioral Risk Factor Surveillance System data from 2014, 2016, and 2018, the authors examined adults 65 years or older. The outcomes examined included annual dental visit and partial and complete tooth loss. Poisson regressions were used to obtain risk ratios after adjusting for covariates. RESULTS States' Medicaid adult dental benefits were significantly associated with dental care use, with low-income older adults in states with no coverage having the lowest probability of visiting a dentist (risk ratio [RR], 0.83; 95% CI, 0.74 to 0.94), followed by emergency-only coverage (RR, 0.91; 95% CI, 0.84 to 0.98) and limited benefits (RR, 0.91; 95% CI, 0.85 to 0.98) relative to states with extensive benefits. There were no significant differences in either partial or complete tooth loss. CONCLUSIONS States' Medicaid adult dental benefits are significantly associated with dental visits among low-income seniors. Providing comprehensive dental benefits under Medicaid can improve access to dental care among low-income older adults. PRACTICAL IMPLICATIONS As the older adult patient population grows, the poorest older adults may face barriers to dental care in the absence of dental coverage. Dental professionals must engage in advocating for comprehensive dental coverage, especially for vulnerable populations.
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20
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Chen Y, Zhang P, Luman ET, Griffin SO, Rolka DB. Incremental Dental Expenditures Associated With Diabetes Among Noninstitutionalized U.S. Adults Aged ≥18 Years Old in 2016-2017. Diabetes Care 2021; 44:1317-1323. [PMID: 33905345 PMCID: PMC8247485 DOI: 10.2337/dc20-2744] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 03/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is associated with poor oral health, but incremental expenditures for dental care associated with diabetes in the U.S. are unknown. We aimed to quantify these incremental expenditures per person and for the nation. RESEARCH DESIGN AND METHODS We analyzed data from 46,633 noninstitutionalized adults aged ≥18 years old who participated in the 2016-2017 Medical Expenditure Panel Survey. We used two-part models to estimate dental expenditures per person in total, by payment source, and by dental service type, controlling for sociodemographic characteristics, health status, and geographic variables. Incremental expenditure was the difference in predicted expenditure for dental care between adults with and without diabetes. The total expenditure for the U.S. was the expenditure per person multiplied by the estimated number of people with diabetes. Expenditures were adjusted to 2017 USD. RESULTS The mean adjusted annual diabetes-associated incremental dental expenditure was $77 per person and $1.9 billion for the nation. Of this incremental expenditure, 51% ($40) and 39% ($30) were paid out of pocket and by private insurance, 69% ($53) of the incremental expenditure was for restorative/prosthetic/surgical services, and adults with diabetes had lower expenditure for preventive services than those without (incremental, -$7). Incremental expenditures were higher in older adults, non-Hispanic Whites, and people with higher levels of income and education. CONCLUSIONS Diabetes is associated with higher dental expenditures. These results fill a gap in the estimates of total medical expenditures associated with diabetes in the U.S. and highlight the importance of preventive dental care among people with diabetes.
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Affiliation(s)
- Yu Chen
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ping Zhang
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Elizabeth T Luman
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Susan O Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah B Rolka
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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21
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Linabarger M, Griffin SO, Hamilton EK. Utility of State-Based Basic Screening Survey Reports for National Oral Health Surveillance in Older Adults. Prev Chronic Dis 2021; 18:E31. [PMID: 33830915 PMCID: PMC8051855 DOI: 10.5888/pcd18.200471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction Untreated dental disease and resulting tooth loss can diminish quality of life for older adults by limiting food choices and discouraging social interaction. Before the Basic Screening Survey (BSS) for older adults, no clinical data were available to monitor the oral health of older adults in long-term care (LTC) facilities at the national level or older adults overall at the state level. Although BSS is widely used, no guidelines exist to ensure the validity, reliability, and comparability of survey information across states. We examined BSS content to help establish reporting guidelines and synthesized findings across states for older adults living in LTC. Methods We systematically reviewed BSS reports published from 2011–2019, assessing how oral health outcomes were measured and reported. For reports that included statewide estimates for LTC residents, we calculated the mean, median, and ranges of 3 preventable oral health conditions and 4 indicators of tooth loss. Results We found wide variation in reporting of sampling, screening, and statistical methods, as well as in indicators of tooth loss. Median prevalence of untreated tooth decay and edentulism (total tooth loss) among LTC adults in 11 states was almost twice that for community-dwelling adults in a national survey. Conclusions The substantial variation in BSS reporting highlights the potential benefits of adopting standardized guidance, which could improve the utility of BSS. Poor oral health outcomes among LTC residents underscore the importance of systematic monitoring of the oral health of this vulnerable population.
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Affiliation(s)
- Molly Linabarger
- Deloitte Consulting LLP, 191 Peachtree St NE, Suite 2000, Atlanta, GA 30303. E-mail:
| | - Susan O Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Griffin S, Thornton-Evans G, Wei L, Griffin P. Disparities in Dental Use and Untreated Caries Prevalence by Income. JDR Clin Trans Res 2021; 6:234-241. [PMID: 32585114 PMCID: PMC10996343 DOI: 10.1177/2380084420934746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Untreated dental caries (UC), although preventable, is the most prevalent disease in the United States. UC diminishes quality of life and lowers productivity for millions of Americans and is notably higher among lower-income compared to higher-income persons. OBJECTIVE This study examines changes in disparities by income in past-year dental use (DU) and UC in 4 life stages (2-5, 6-19, 20-64, and ≥65 y) between 1999-2004 and 2011-2016. We also examined changes in dental safety net policies during this time. METHODS We obtained data on dependent variables, UC and DU, from cross-sectional, nationally representative surveys for 1999-2004 and 2011-2016. We used multivariable regression models with 3 main-effect explanatory variables: income (<200% or ≥200% federal poverty level), life stage, and survey period (1999-2004 or 2011-2016) and sociodemographic variables. We included 2-way interaction terms among main-effect variables to test whether disparities had changed over time in each life stage and a 3-way term to test changes in disparities differed across life stages. RESULTS Model-adjusted disparities in DU decreased for both preschool-age and school-age children, and disparities in UC decreased for school-age children. Changes in DU and UC disparities were not detectable for working-age adults and increased for retirement-age adults. Changes in DU and UC among preschool and school-age children were not significantly different from one another and were significantly different from changes among retirement-age adults. Compared to working-age adults, changes in disparities for DU and UC were significantly different for school-age children, and changes in DU were significantly different for preschool-age children. Between surveys, the dental safety net was expanded for youth but remained largely unchanged for adults. CONCLUSIONS Expanding the dental safety net for youth could have contributed to increased access to dental care among children relative to adults and contributed to the decrease in disparities in DU and UC among youth. KNOWLEDGE TRANSFER STATEMENT Between 1999-2004 and 2011-2016, the dental safety net was expanded for youth but remained largely unchanged for adults. Using national survey data to compare changes in disparities in past-year dental use and untreated dental caries by income between adults and youth sheds light on the potential impact of expanding the dental safety net.
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Affiliation(s)
- S.O. Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - G. Thornton-Evans
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - L. Wei
- DB Consulting Group, Inc., Atlanta, GA, USA
| | - P.M. Griffin
- Regenstrief Center for Healthcare Engineering, Purdue University, West Lafayette, IN, USA
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23
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Thompson LA, Chen H. Physiology of Aging of Older Adults: Systemic and Oral Health Considerations-2021 Update. Dent Clin North Am 2021; 65:275-284. [PMID: 33641753 DOI: 10.1016/j.cden.2020.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most oral health care providers encounter older adults in their practices and can play a critical role in supporting independence and quality of life for this aging cohort. Physiologic and structural oral cavity changes associated with normal aging may affect the presentation and oral health care of older adults. This article reviews the normative aging of dentition and oral structures and physiologic changes associated with normal aging, including cardiovascular, metabolic, and musculoskeletal changes, and how they may affect oral health. Oral health providers should be aware of normal aging processes when they plan care or schedule procedures for older adults.
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Affiliation(s)
- Lisa A Thompson
- Geriatric Dental Fellowship, Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA
| | - Helen Chen
- Hebrew SeniorLife, Boston, MA, USA; Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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24
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Mueldener EJ, McQuistan MR, Qian F, Hartshorn JE, Oishi MM. An evaluation of the geriatric dental curricula within Advanced Education in General Dentistry and General Practice Residency programs in the United States. SPECIAL CARE IN DENTISTRY 2020; 41:210-217. [PMID: 33382104 DOI: 10.1111/scd.12553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To compare the geriatric dentistry curricula between Advanced Education in General Dentistry (AEGD) and General Practice Residency (GPR) programs. METHODS A 108-item survey was developed to assess residents' didactic and clinical experiences pertaining to geriatric patients. Surveys were mailed in 2018 to all AEGD (N = 89) and GPR (N = 180) program directors. Statistical analysis consisted of descriptive and bivariate analyses with the chi-square test, Fisher's exact test, and the Wilcoxon rank sum test (alpha = .05). RESULTS Twenty-four AEGD and fifty-eight GPR directors completed surveys (response rate = 30%). Seventy-one percent of responding programs reported mandatory didactic training pertaining to frail and functionally dependent geriatric adults. Ninety-nine percent of respondents reported that residents provided treatment to geriatric patients; however, they were less likely to perform procedures on frail and functionally dependent patients. Only 15% of respondents provided nursing home care. Considering all patient encounters, responding GPR programs were more likely than AEGD programs to treat patients using IV bisphosphonates (63% vs 25%; P < .01), undergoing chemotherapy (48% vs 16%; P = .02), and undergoing head and neck radiation therapy (55% vs 25%; P = .02). CONCLUSION A majority of responding AEGD and GPR programs reported providing educational experiences pertaining to geriatric patients; however, GPR programs reported treating more medically complex patients than AEGD programs.
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Affiliation(s)
- Emma J Mueldener
- Hospital Dentistry Institute, University of Iowa, Iowa City, Iowa
| | - Michelle R McQuistan
- Division of Biostatistics and Computational Biology, Iowa Institute for Oral Health Research, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Fang Qian
- Preventive and Community Dentistry, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Jennifer E Hartshorn
- Division of Biostatistics and Computational Biology, Iowa Institute for Oral Health Research, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
| | - Matthew M Oishi
- Division of Biostatistics and Computational Biology, Iowa Institute for Oral Health Research, University of Iowa College of Dentistry and Dental Clinics, University of Iowa, Iowa City, Iowa
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Northridge ME, Wu Y, Troxel AB, Min D, Liu R, Liang LJ, Metcalf SS, Seyedzadeh Sabounchi S, Yi S. Acceptability of a community health worker intervention to improve the oral health of older Chinese Americans: A pilot study. Gerodontology 2020; 38:117-122. [PMID: 33368603 DOI: 10.1111/ger.12522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/01/2020] [Accepted: 12/12/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To evaluate the acceptability of a community health worker (CHW) intervention designed to improve the oral health of low-income, urban Chinese immigrant adults. BACKGROUND Given that both dental caries and periodontitis are behaviourally mediated, biofilm-based diseases that are largely preventable with attention to regular oral hygiene practices and preventive dental visits, strategies to arrest or even heal carious lesions and high-quality maintenance care and plaque control without the need to resort to aerosol-generating surgical approaches are evidence-based best practices. Older immigrants have poorer oral health than older US-born natives, motivating the need for delivery of more effective and affordable services to this vulnerable population. MATERIALS AND METHODS CHWs were trained by the NYU College of Dentistry dental hygienist faculty members using dental models and flip charts to instruct patients on proper brushing and flossing techniques. In addition, they discussed the presented oral health promotion information one-on-one with patients, addressed any expressed concerns and encouraged prevention of oral conditions through regular dental visits and brushing with fluoride toothpaste. RESULTS More than 98% of the 74 older Chinese adult participants strongly agreed/agreed that the CHWs helped them to improve how they take care of their health, the CHWs answered their questions and concerns, the information and topics were informative, and the in-person demonstrations were helpful in improving oral health. CONCLUSION The health of all communities depends on access to comprehensive care, including oral health care, in the wake of COVID-19. CHW interventions are acceptable to and may reach marginalised and immigrant communities.
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Affiliation(s)
- Mary E Northridge
- Division of Dental Medicine, Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Yinxiang Wu
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Andrea B Troxel
- Division of Biostatistics, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Deborah Min
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Rong Liu
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Li Juan Liang
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Sara S Metcalf
- Department of Geography, The State University of New York at Buffalo, Buffalo, NY, USA
| | - Shabnam Seyedzadeh Sabounchi
- Division of Dental Medicine, Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Stella Yi
- Division of Health and Behavior, Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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26
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Schensul JJ, Salvi A, Ha T, Grady J, Li J, Reisine S. Evaluating Cognitive/Emotional and Behavioral Mediators of Oral Health Outcomes in Vulnerable Older Adults. J Appl Gerontol 2020; 41:187-197. [PMID: 33292050 DOI: 10.1177/0733464820974920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Inconsistent outcomes of oral hygiene interventions require testable theories combining cognitive and behavioral domains to guide intervention and improve results. This article evaluates the integrated model as a cognitive-behavioral approach to improve oral health clinical outcomes in ethnically diverse low-income older adults. Baseline data from a clinical trial utilizing the integrative model (IM) model evaluated predictors of gingival index (GI) and plaque score (PS). Individual logistic regression was performed for all predictors in relation to GI and PS. Multiple logistic regression was performed with significant predictors of GI and PS only. Greater locus of control and more brushing predicted lower GI; greater locus of control predicted lower PS. Both cognitive and behavioral domains impact GI, requiring more prolonged effort for improvement while locus of control, a cognitive variable, predicts PS, immediately improved by daily brushing/flossing. A streamlined IM including locus of control and tooth brushing should improve oral hygiene of low-income older adults.
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Affiliation(s)
| | | | - Toan Ha
- University of Connecticut School of Medicine, Farmington, USA
| | - James Grady
- University of Connecticut School of Medicine, Farmington, USA
| | - Jianghong Li
- Institute for Community Research, Hartford, CT, USA
| | - Susan Reisine
- University of Connecticut School of Dental Medicine, Farmington, USA
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27
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Naavaal S, Griffin SO, Jones JA. Impact of Making Dental Care Affordable on Quality of Life in Adults Aged 45 Years and Older. J Aging Health 2020; 32:861-870. [PMID: 31258028 PMCID: PMC7978487 DOI: 10.1177/0898264319857967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: The objective of this study was to examine the associations between self-reported ability to afford dental care and quality of life in adults aged 45 years and older. Method: We used publicly available cross-sectional data from the 2008 National Health Interview Survey and its oral health supplement for 11,760 adults aged 45+ years. The increased probabilities of reporting dental problems attributable to an inability to afford dental care were estimated from multivariate models and combined with respective dental problem disability weights from the Global Burden of Disease to measure loss in quality of life. Results: Prevalence of reported inability to afford dental care, severe tooth loss, severe periodontitis, and untreated caries were 11.9%, 8.5%, 14.3%, and 37.9%, respectively. Inability to afford dental care was associated with an increase of 0.017 disability-adjusted life-years (DALYs) per person per year under base case and 0.020 DALYs under generous assumptions. Conclusion: Making dental care affordable could improve adult's (age 45 and above) quality of life at a reasonable cost.
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Affiliation(s)
- Shillpa Naavaal
- Oral Health Promotion and Community Outreach, School of Dentistry, Virginia Commonwealth University, Richmond, USA
| | - Susan O. Griffin
- Division of Oral Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Griffin SO, Griffin PM, Li C. Reply to Changes in Institutionalized Older People's Dentition Status in Helsinki 2003 to 2017. J Am Geriatr Soc 2020; 68:223-224. [DOI: 10.1111/jgs.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 09/23/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Susan O. Griffin
- Division of Oral HealthCenters for Disease Control and Prevention Atlanta Georgia
| | - Paul M. Griffin
- Regenstrief Center for Health Care EngineeringPurdue University West Lafayette Indiana
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Saarela RK, Hiltunen K, Mäntylä P, Pitkälä KH. Changes in Institutionalized Older People's Dentition Status in Helsinki, 2003‐2017. J Am Geriatr Soc 2019; 68:221-223. [DOI: 10.1111/jgs.16230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 08/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Riitta K.T. Saarela
- City of Helsinki, Department of Social Services and Health CareOral Health Care Helsinki Finland
| | - Kaija Hiltunen
- Department of Oral and Maxillofacial Diseases, Faculty of MedicineUniversity of Helsinki Helsinki Finland
| | - Päivi Mäntylä
- Department of Oral and Maxillofacial Diseases, Faculty of MedicineUniversity of Helsinki Helsinki Finland
- Institute of Dentistry, University of Eastern Finland Kuopio Finland
- Kuopio University Hospital, Oral and Maxillofacial Diseases Kuopio Finland
| | - Kaisu H. Pitkälä
- Department of General Practice and Primary Health CareUniversity of Helsinki Helsinki Finland
- Helsinki University Hospital, Unit of Primary Health Care Helsinki Finland
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Zhang W, Wu YY, Wu B. Racial/Ethnic Disparities in Dental Service Utilization for Foreign-Born and U.S.-Born Middle-Aged and Older Adults. Res Aging 2019; 41:845-867. [PMID: 31272288 DOI: 10.1177/0164027519860268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study examines racial/ethnic disparities of dental service utilization for foreign-born and U.S.-born dentate residents aged 50 years and older. Generalized linear mixed-effects models (GLMM) were used to perform longitudinal analyses of five-wave data of dental service utilization from the Health and Retirement Study (HRS). We used stratified analyses for the foreign-born and U.S.-born and assessed the nonlinear trend in rates of dental service utilization for different racial/ethnic groups. Findings indicate that Whites had higher rates of service utilization than Blacks and Hispanics regardless of birthplace. For all groups, the rates of service utilization decreased around age 80, and the rates of decline for Whites were slower than others. The U.S.-born showed the trend of higher rates of service utilization than the foreign-born for all racial/ethnic groups. These findings suggest the importance of developing culturally competent programs to meet the dental needs of the increasingly diverse populations in the United States.
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Affiliation(s)
- Wei Zhang
- 1 Department of Sociology, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Yan Yan Wu
- 2 Office of Public Health Studies, University of Hawai'i at Mānoa, Honolulu, HI, USA
| | - Bei Wu
- 3 Rory Meyers College of Nursing, New York University, New York, NY, USA
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